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Objectives: To investigate how guideline development groups collect and manage conflicts of interest (COI) when producing electronic cigarette (e-cigarette) recommendations., Study Design and Setting: Public health bodies that had produced e-cigarette recommendations were identified from four purposively selected jurisdictions (World Health Organization, United Kingdom, Australia, and United States). We analysed their COI policies and conducted 15 interviews with guideline methodologists, policymakers, and academics in guideline development groups., Results: Only five of 10 public health bodies had a publicly available COI policy. Participants discussed the importance of those involved in the development process declaring COI. However, there were differences in who had to report COI, the time period asked about, and what and how declarations are made. COI policies and participants discussed a range of approaches for managing COI, from limiting involvement to disqualification from the recommendation development process. Participants considered the current processes for collecting and managing COI insufficient due to their open interpretation and possibility for partial declarations of interest., Conclusion: The management of COI varies across public health bodies, with little standardization and lack of transparency. To improve the collection and management of COI, and ultimately increase the trustworthiness of recommendations, guideline development groups should draw upon a comprehensive and accessible COI policy., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)